Surgical management of fracture-related infection (FRI) in the proximal femur: treatment options and long-term outcome.

BACKGROUND

The treatment of fracture-related infection (FRI) in the proximal femur presents a challenge due to the need to maintain both stability and function of the hip joint while eradicating the infection. This study aimed to analyze the outcomes of antibiotic-loaded bone cement(ALBC) combined with a locking plate for the treatment of these patients.

PATIENTS AND METHODS

From January 2013 to January 2024, adult patients diagnosed with FRI in the proximal femur were included. All were treated with ALBC combined with a locking plate after debridement at our clinical center. Patients with a minimum of 2 years of follow-up, along with clinical and functional results, were retrospectively analyzed.

RESULTS

A total of 83 consecutive patients were included. The initial osteosynthesis was with a nail in 56(67.5%) patients and with a plate in 27(32.5%). The S. epidermidis (20.5%) was the most common pathogen, followed by S. aureus (16.9%) and E. coli (14.5%). A staged reconstruction procedure was performed in 61 (73.5%) patients due to larger bone defects. After a median follow-up of 36 (range: 24-72) months, nine patients (10.8%) required additional revision, with seven due to recurrence and two due to nonunion. Infection-free bone union was achieved in all patients (100%) at the final follow-up. A significant increase in the Harris hip score (HHS) was observed, from a preoperative value of 65.7 ± 10.6 to a postoperative value of 84.3 ± 7.5 (P > 0.05). No cases of re-fractures or implant/cement spacer loosening were reported. Univariate analysis showed that prolonged infection duration, diabetes, and systemic diseases were associated with the additional revision.

CONCLUSION

The use of ALBC combined with a locking plate served as a low-burden alternative in management of FRIs in the proximal femur, effectively reconciling infection eradication with functional preservation. Prolonged infection duration and increased comorbidities complicated the treatments.